Alcoholism - Primary Illness
By William Hay
Alcoholism is a primary illness. It is a disease. Dr. Rush, the father of American Psychiatry called it such over a hundred years ago. That there remains confusion about this concept is only evidence of the perniciousness of myth and vested interests.
Alcoholism is not “self-medication”. If a person is regularly using alcohol as a “medication” for social or environmental difficulties then they are at risk for the illness of alcoholism. Alcohol is a depressant. When people who are depressed begin to use a depressant for treatment then it is a pretty good indication of the insaniety of denial that complicates both depression and alcoholism.
The two principal conditions that are confused with alcoholism are anxiety disorders and mood disorders. These disorders are in themselves not diseases. They are merely descriptions of symptoms like a “fever” is a description of a sympton. Mood and Anxiety are the “fevers” of mental illness. They are not primary diseases. Alcoholism has more claim for being a primary “disease” than than the ‘disorders’ that commonly accompany it.
The concept of primary disease derived from Koch’s Principles. Koch’s Principles required that a particular condition be initiated and associated with a specific phenomena which gave rise to a specific set of symptoms or syndrome and that when that agent was not present that syndrome was absent and the removal of the agent would remove the symptoms.
Alcohol presents a demonstrable change in person and behaviour acutely. At 100 mg/dl of alcohol we see strong evidence of intoxication in most individuals and at 800 mg/dl of alcohol we see death.
In the chronic use of alcohol we see a particular pattern of loss of control over drinking and increasingly all activities are related to drinking and eventually a considerable portion of the individuals’ day is spent intoxicated, thinking about being intoxicated, recovering from intoxication or seeking to be intoxicated. At the end result all other pleasures and activities are forsaken for the experience of intoxication.
There is a vast difference between a person who has a social drink and a person who suffers the disease of alcoholism. 10% of the population consume 80% of the country’s alcohol. There at least is the suggestion that a social drinker consider that their alcoholic compatriot is consuming 8 times at least the amount that they do. The comparison can be made with the “reckless drivers”. Whereas the average driver mostly follows the speed limit the “reckless driver” rarely follows the speed limit.
The argument that is used to confuse is akin the food argument. Medically Obese people are 50 lbs over their upper limit of their “healthy” weight for age and height. They come to me as a condition because they need bilateral hip replacement because the body’s shocks have given in under the extended strain of supporting such an abnormal weight. Hence, just because there are weight restrictions on elevators doesn’t mean that elevators cannot run normally with proper awareness of engineering stresses and tolerances.
If you use alcohol in moderation to facilitate the enjoyment of your normal life activities then you are quite simply not an alcoholic. Low risk alcohol use has been clearly defined by public health standards, well researched, and easily reproducible. For an adult male these figures are no more than 14 drinks a week, and no more than 4 drinks at one sitting. For a woman and the elderly these are 7 drinks a week and no more than 7 drinks a week and no more than 3 drinks at any one sitting. A drink is defined as equivalent to one and ½ ounces of liquor.
The difference between the sexes and with age is simply a product of gender and age differences in metabolism. This is not related to those who would maintain that they can “hold” their liquor. Those who maintain that they can “hold” their liquor are merely advanced in the illness of alcohol and no longer subjectively sense their degree of impairment which has been well documented in studies of such individuals with motor behavioural tasks. They do abysmally which is why they also so often claim to be able to drive yet account so many motor vehicle accidents.
In contrast the gender differences and age differences are related to the metabolism of alcohol in the stomach. Women have less of the enzyme in the stomach that accounts for the initial breakdown of alcohol so are most sensitive to the initial effects of intoxication. The elderly have reduced liver capacity for detoxification of alcohol so are similiarly at greater risks.
This is just for starts. The brain of a person addicted to alcohol is a changed brain. There is ample evidence today to support the ‘disease” model of alcoholism, more so indeed than many ‘accepted’ diseases, especially in the so called area of mental illness. However with alcoholism there is also overwhelming evidence of widespread organ damage directly a consequence of continued alcohol abuse. Alcoholic dementias are just the end stage of repeated mental chemical trauma. Anxiety disorders, mood disorders, psychoses, and seizures are all routinely seen in alcoholics, as is heart disease, liver disease, pancreatitis, gastritis, blood disorders, immunological disorders, and various cancers.
Alcoholism has well been called the great chameleon of disease.
It’s also been called the disease of denial not just for the individual alcoholic, but for the family, the medical profession at large, definitely psychiatry, the community in general and those with major financial invested interests not so different from the tobacco companies.
That said, it is as amazing to me that as many individuals and organizations within these very groups are continuing to help alcoholics and address the vary same forces that allowed the tobacco lobbies to profit from the illness of addiction. Alcoholism is a primary illness.